Treatment of Celiac Artery Compression Syndrome in Median Arcuate Ligament Syndrome with Pancreaticoduodenal Artery Aneurysm

Clinical Scenario

This protocol addresses celiac artery compression syndrome occurring in the specific setting of median arcuate ligament syndrome (MALS) complicated by a pancreaticoduodenal artery (PDA) aneurysm — a presentation that demands a structured, staged management strategy.

Clinical Situation

MALS with secondary visceral artery aneurysm is an exceptionally rare entity, representing approximately 2% of all abdominal aneurysms. Notably, MALS-associated aneurysms can account for nearly 70% of pancreaticoduodenal artery aneurysms, making this an important subtype when it occurs. Failure to recanalize the celiac artery in this setting is associated with recurrent visceral artery aneurysm formation on long-term follow-up.

Treatment Approach (partial)

Management involves a staged strategy in which transcatheter embolization of the affected artery is combined with a subsequent surgical ligament release procedure — with an alternative vascular bypass approach considered in specific anatomical circumstances. The complete protocol with full sequencing is behind the link below.

Treatment Goals

Recanalization of the celiac artery and prevention of recurrent visceral artery aneurysms.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3390/jvd4010011

Complex treatment strategy is described for aneurysms secondary to MALS which is an extremely rare pathology accounting for 2% of all abdominal aneurysms.

However, MALS aneurysms can account for almost 70% of pancreatoduodenal artery (PDA) aneurysms.

The recommended treatment strategy for MAL is transcatheter PDA embolization with PTA and celiac trunk stenting in the first stage and MALR in the second stage.

It is also possible to perform an aorto-hepatic by-pass in the first stage, reducing the hyperkinetic circulation.

This treatment strategy may be considered in cases of celiac trunk closure and critical SMA stenosis.

It is extremely important to recanalize the CA because in long-term follow-up, failure to recanalize the CA results in recurrent visceral artery aneurysms.

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